Determinants of outcomes after resection of renal cell carcinoma with venous involvement

Sidana, Abhinav; Goyal, Jatinder; Aggarwal, Piyush; Verma, Parag; Rodríguez, Ronald

doi:10.1007/s11255-012-0314-x

Cited by 41 publications

(30 citation statements)

References 26 publications

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“…Some studies have found that extent of vena caval invasion was an important prognostic factor and that in majority of patients with positive vascular wall margins have increased recurrence rate (Abel et al, 2013). While according to some authors, survival is determined by the inherent aggressiveness of the cancer and that tumor thrombus level does not predict recurrence or mortality (Sidana et al, 2012). In our study, 10% (5/50) cases showed renal vein invasion.…”

Section: Discussionmentioning

confidence: 42%

Clinicopathologic Patterns of Adult Renal Tumors in Pakistan

Hashmi

Ali²,

Hussain³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Background: Renal cancer is a serious public health problem which may be under reported and registered in our setup, since the Karachi cancer registry documented only 43 cases out of 4,268 incident cancer cases over 3 year duration. Therefore we aimed to determine the clinicopathologic characteristics of adult renal tumors in our setup. Materials and Methods: The study was conducted in histopathology department, Liaquat National Hospital and included total of 68 cases of adult renal tumors over 4 years. Detailed histopathologic characteristics of tumors were analyzed. Results: Mean age of patients was 56.4 (18-84) years. Renal cell carcinoma (RCC) was the most common cell type (78%) cases; followed by transitional/urothelial carcinoma (12.5%), leiomyosarcoma (4.7%), oncocytoma (1.6%), squamous cell carcinoma (1.6%) and high grade pleomorphic undifferentiated sarcoma (1.6%). Among 50 RCC cases; 62% were conventional/clear cell RCC (CCRCC) type followed by papillary RCC(PRCC), 24%; chromophobe RCC(CRCC), 6% and sarcomatoid RCC(SRCC), 8%. Mean tumor size for RCC was 7.2 cm. Most RCCs were intermediate to high grade (60% and 40% respectively). Capsular invasion, renal sinus invasion, adrenal gland involvement and renal vein invasion was seen in 40%, 18%, 2% and 10% of cases respectively. Conclusions: We found that RCC presents at an earlier age in our setup compared to Western populations. Tumor size was significantly larger and most of the tumors were of intermediate to high grade. This reflects late presentation of patients after disease progression which necessitates effective measures to be taken in primary care setup to diagnose this disease at an early stage.

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Section: Discussionmentioning

confidence: 42%

Clinicopathologic Patterns of Adult Renal Tumors in Pakistan

Hashmi

Ali²,

Hussain³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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“…Main surgical access in patients with extended thrombus was median incision (47.4 %). To date, in cases when thrombus level extends the intra-and suprahepatic section of the IVC, surgery is associated with acceptable perioperative morbidity and mortality rates (Clavien classification ≥IV) [6][7][8]. Recent studies show lower mortality and perioperative complications compared with those from the 1970s to 1990s [9,10].…”

Section: Discussionmentioning

confidence: 99%

“…Several clinicopathological risk factors increasing disease-associated mortality are described. Diverse studies showed metastatic disease [3,5,6,8,10,12,15,16], lymph node-positive disease [3,5,10,12,15], poor Eastern Cooperative Oncology Group (ECOG) performance status [5], sarcomatoid histopathological features [5,15], advanced local tumour stage [8], concomitant perinephritic fat invasion [5,12] and Fuhrman grade [3,12] to be independent prognostic factors [5]. Bertini et al [15] showed reduced survival of patients with friable thrombus consistency compared with solid IVC thrombi.…”

Section: Discussionmentioning

confidence: 99%

Renal cell carcinoma and tumour thrombus in the inferior vena cava: clinical outcome of 98 consecutive patients and the prognostic value of preoperative parameters

Niedworok

Dörrenhaus

Dorp³

et al. 2014

World J Urol

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“…In particular it was shown that tumor thrombus level does not predict recurrence or mortality in this group of ccRCC patients who present with IVC involvement in the renal vein (Group 1) or subdiaphragmatic IVC tumor thrombus (Group 2), in comparison to involvement of IVC above diaphragm or atrial extension (Group 3). Survival is determined by inherent aggressiveness of the cancer manifested by tumor size, grade and distant metastasis at presentation [28]. Pre-surgical treatment with sunitinib is able to ease surgery for ccRCC tumor thrombi and surgery after sunitinib treatment may be possible without additional morbidity.…”

Section: Discussionmentioning

confidence: 99%

Renal cell carcinoma with intramyocardial metastases

et al. 2014

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BackgroundCardiac metastases from renal cell carcinoma without vena caval involvement are extremely rare with a limited number of cases reported in the worldwide literature until now. Nevertheless, this rare location of metastasis may significantly influence patient treatment and prognosis. Cooperation between oncology, cardiology, and urology teams are indispensable in cases of patients suffering from intramyocardial tumors. For these individuals, treatment guidelines based on large-scale studies are unavailable and only case/case series analysis may provide clinicians with decision assistance.Case presentationIn this paper, we report a case of a 50-year-old Caucasian male diagnosed with a 10.2 × 10.3 × 10.0 cm lower pole left renal mass in January 2002. He was subsequently treated with immunochemotherapy, tyrosine kinase inhibitors (TKIs), and mTOR inhibitors (mTORIs) - that is sunitinib, everolimus, and sorafenib. In March 2012, contrast-enhancing tumors in the left myocardium (∅22 mm) and in the interventricular septum (∅26 mm) were seen on CT. Cardiology testing was conducted and the patient was treated with pazopanib with a profound response. Overall survival since the clear cell renal cell carcinoma (ccRCC) diagnosis was 11 years 2 months and since diagnosis of multiple heart metastases was 1 year.ConclusionsCardiac metastases present a unique disease course in renal cell carcinoma. Cardiac metastases may remain asymptomatic, as in the case of this patient at the time of diagnosis. The most common cardiac presentation of renal cell carcinoma is hypertension, but other cardiac presentations include shortness of breath, cough, and arrhythmias. Targeted systemic therapy with tyrosine kinase inhibitors may be useful for this group of patients, but necrosis in the myocardium can result in tamponade and death. Regular cardiac magnetic resonance imaging scans are required for treatment monitoring.

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Determinants of outcomes after resection of renal cell carcinoma with venous involvement

Abstract: Tumor thrombus level does not predict recurrence or mortality in RCC with venous involvement. Survival is determined by inherent aggressiveness of the cancer manifested by tumor size, grade and distant metastasis at presentation.

Cited by 41 publications

References 26 publications

Clinicopathologic Patterns of Adult Renal Tumors in Pakistan

Clinicopathologic Patterns of Adult Renal Tumors in Pakistan

Renal cell carcinoma and tumour thrombus in the inferior vena cava: clinical outcome of 98 consecutive patients and the prognostic value of preoperative parameters

Renal cell carcinoma with intramyocardial metastases

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